Ateş Oğuz, Hakgüder Gülce, Kart Yeliz, Olguner Mustafa, Akgür Feza M
Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Balcova, Izmir 35340, Turkey.
J Pediatr Surg. 2007 Jul;42(7):1271-5. doi: 10.1016/j.jpedsurg.2007.02.020.
BACKGROUND/PURPOSE: During a 1-stage transanal endorectal pull through (OS-TERP) for Hirschsprung's disease (HD), dilated ganglionic segment (DGS) may pose a problem during coloanal anastomosis. Apart from the anorectal problems occurring after the HD operations, lower urinary tract problems may also be encountered. The anorectal and lower urinary tract system functions of the patients that underwent OS-TERP in the presence of DGS were evaluated.
From 2000 to 2005, 15 patients (14 boys and 1 girl) underwent OS-TERP for HD. During the presence of DGS, the coloanal anastomosis of the DGS was completed without any tapering or excision. Hospital and digital video records of all the patients who underwent OS-TERP were evaluated, and the operation time, complications, and follow-up periods of the patients were compared. Standard urodynamic studies were performed after at least 6 months. Bladder capacity; mean bladder capacity ratio; maximum filling pressure; the number of contractions during the filling phase; intraabdominal, intravesical, and detrusor pressures; residual urinary volume; and electromyography activities of the pelvic floor muscles were evaluated.
Six patients had ganglionic segment of normal caliber, whereas 9 patients had DGS. Duration of the operation was significantly longer in the DGS group. One patient in DGS group experienced a single episode of enterocolitis in the postoperative period. Transient urinary retention occurred in another patient in DGS group. In ganglionic segment of normal caliber group, one patient experienced 2 episodes of enterocolitis in the postoperative period. Urodynamic study of the 7 patients in the DGS group had postvoiding urine volume of less than 20 mL. The detrusor activities of all the patients were found to be normal. None of the patients had developed urinary tract problems during the follow-up period.
With the coloanal anastomosis technique, we have described that narrowing the DGS to anal caliber step by step without any excision or tapering enables DGS to fit to the anus easily. Although further clinical studies with larger sample sizes are necessary, present study may imply that OS-TERP performed in the presence of a DGS may not increase morbidity and affect anorectal functions. The normal urodynamic study results obtained in this study may imply that OS-TERP procedure may be performed safely in the presence of DGS.
背景/目的：在一期经肛门直肠内拖出术（OS-TERP）治疗先天性巨结肠（HD）过程中，扩张的神经节段（DGS）在结肠肛管吻合时可能会带来问题。除了HD手术后出现的肛肠问题外，还可能会遇到下尿路问题。对存在DGS的情况下接受OS-TERP治疗的患者的肛肠和下尿路系统功能进行了评估。
2000年至2005年，15例患者（14例男孩和1例女孩）接受了OS-TERP治疗HD。在存在DGS的情况下，DGS的结肠肛管吻合在不进行任何缩窄或切除的情况下完成。对所有接受OS-TERP治疗的患者的医院记录和数字视频记录进行评估，并比较患者的手术时间、并发症和随访时间。至少6个月后进行标准尿动力学研究。评估膀胱容量；平均膀胱容量比；最大充盈压力；充盈期收缩次数；腹内压、膀胱内压和逼尿肌压力；残余尿量；以及盆底肌肉的肌电图活动。
6例患者神经节段管径正常，而9例患者有DGS。DGS组的手术时间明显更长。DGS组1例患者术后发生单次小肠结肠炎。DGS组另1例患者出现短暂性尿潴留。在神经节段管径正常组，1例患者术后发生2次小肠结肠炎。DGS组7例患者的尿动力学研究显示排尿后尿量少于20 mL。所有患者的逼尿肌活动均正常。随访期间所有患者均未出现尿路问题。
通过结肠肛管吻合技术，我们描述了在不进行任何切除或缩窄的情况下逐步将DGS缩窄至肛管口径，可使DGS轻松适配肛门。尽管需要进行更大样本量的进一步临床研究，但目前的研究可能意味着在存在DGS的情况下进行OS-TERP可能不会增加发病率并影响肛肠功能。本研究获得的正常尿动力学研究结果可能意味着在存在DGS的情况下可以安全地进行OS-TERP手术。
